1. Field of the Invention
The present invention concerns an osteotomy device, in particular for the performance of SCARF osteotomy, well known to the practitioners, and especially for the performance of extreme SCARF (large displacement) in the treatment of severe Hallux Valgus.
However, this device is perfectly suitable for the performance of moderate SCARF, or also for the attachment of osteotomy of the first row on so-called extreme SCARF on the occasion of simple surgical reviews, or for example for osteoporotic patients for whom only the cortex (the cortical) is solid (even abnormally rigid).
2. Description of Related Art Including Information Disclosed Under 37 CFR 1.97 and 37 CFR 1.98
Hallux Valgus is a very widespread deformation of the foot corresponding to the deviation of the first metatarsal and the big toe of the first row. The inter-metatarsal angle I (between the metatarsals of the first and second rows) and the Hallux Valgus angle HV (between the metatarsus of the first row and the big toe) are radiographic measures commonly used to assess the degree of deformity of the metatarsus of the first row. These measures made it possible to establish the following classification: a Hallux Valgus is considered to be:                normal if: HV<15° and IM<9°        average if: 15°<HV<20° and 9°<IM<11°        moderate if: 20°<HV<40° and 11°<IM<16°        severe if: HV>40° and IM>16°        
Several techniques exist to correct these deformities, with the intervention always occurring on the first metatarsus:                osteotomy of the head of the first metatarsus (Reverdin Isham osteotomy) which allows redirecting the articular surface of the metatarsus and thereby correcting the deformity;        Keller's operation corresponding to an arthroplasty by resection of the base of the first phalange of the big toe which remains in use in cases of arthrosic degeneration of the first metatarso-phalangeal joint;        arthrodesis or metatarso-phalangeal “fusion” of the big toe.        
The most common techniques remain however:                diaphyseal osteotomy such as SCARF osteotomy;        basal osteotomy such as chevron osteotomy or opening osteotomy with or without filling with graft.        
It is possible to combine these interventions on the first metatarsus with the correction of the first phalange, for example by Akin osteotomy which corrects the valgus on the first phalange.
All these techniques provide good clinical and radiographic results. However, certain complications may occur such as the risk of thrombosis, of recurrence of Hallux Valgus, a “tile” effect (encasing of the two bone fragments), or metatarsalgia (pain in the forefoot, opposite the metatarsals).
The various studies undertaken in this field indicate that SCARF osteotomies provide an efficient method for the treatment of severe Hallux Valgus. However the devices currently available are not indicated for the correction of severe Hallux Valgus by the extreme SCARF technique.
In effect, for example, osteotomy plates are known which feature a first part intended to be applied to and fastened on the cortical substance of the bone to be treated, and a second part intended to be buried in the central medullary, in the diaphyseal portion of the bone to be treated.
For example, document WO-2012/112642 discloses an orthopedic plate with a first end featuring a locking screw hole intended for receiving a locking screw and, at a distance from this locking hole, a compression housing which extends from the face of the plate opposite the bone and which receives a compression screw the axis of which forms an angle between 10° and 70° with the longitudinal axis of the plate. This plate features also a second end with a chamfer to ensure the insertion of said plate into the bone.
This plate is especially indicated for corrections of Hallux Valgus through the CHEVRON technique. It is not appropriate for implementing the SCARF technique, and even less for extreme SCARF for treatment of severe Hallux Valgus.
Furthermore, the presence of the housing for the compression screw which extends from the lower face (intended to be applied opposite the bone to be treated), makes the device very complex to use.
One is also familiar with document US-2009/0036931 which discloses a plate for orthopedic surgery for osteosynthesis of bone fragments of the foot, this plate including a proximal portion intended to be placed and to be fastened on the external face of the first bone fragment, this proximal portion including at least one opening for passage of an orthopedic screw, and a distal portion intended to be placed in the central medullary housing of the second bone fragment, this distal portion likewise presenting at least one opening for passage of an orthopedic screw.
This plate is especially indicated for performing subcapital osteotomy or even for performing Lapidus arthrodesis.
Furthermore, its implementation, especially because of the need to screw orthopedic screws into the distal portion intended to be placed in the central medullary portion of the bone fragment, requires special instrumentation, as well as long and meticulous set-up time.
Even though this plate does not have a cumbersome, protruding housing, it is still not appropriate for application of the SCARF technique, and even less so for extreme SCARF for the treatment of severe Hallux Valgus.
In addition, each of the plates disclosed in documents WO-2012/112642 and US-2009/0036931 features a blade intended for insertion in the central medullary portion of the bone to be treated. This blade of a generally flat shape is cumbersome and difficult to insert into the spongy mass of the central medullary part and requires specific instrumentation adapted to its shape.
In addition, its end is slightly sharpened so as to be able to hollow out its seat in the central medullary part as the risk of damaging the internal cortical at said central medullary part.
These rigid blades cannot be shaped, or at least not in all directions.
One aim of the present invention is to offer practicing surgeons a device for extreme movement osteotomy, particularly for performing extreme SCARF in the treatment of severe Hallux Valgus that does away with the aforementioned disadvantages.